Minister Simon Harris at the meeting in Portlaoise earlier in 2017 .
Health service management wanted to begin executing the downgrade of Portlaoise hospital in early 2017 and start moving services out in 2022 except A&E which would scale back sooner.
'The Development of an action plan for a new model of clinical service delivery in the Dublin Midlands Hospital Group' goes well beyond outlining what should be done at Portlaoise and its sister hospitals.
The plan was submitted to the Department of Health in late 2016 but has been subject to change since then. However, it is clear that its implementation is already behind schedule.
Under a heading 'delivery timelines' it says the downgrade process should already have started. It said the 'earliest possible date for the commencement of the transition of clinical services by 2022'.
"Implementation planning shall commence early 2017 to ensure capacity and capability is in place across the Dublin Midlands Hospital Group and with the key service partners to support a safe and successful change," says the plan.
The plan says a key consideration is that reconfiguration must 'simultaneously transition on a specific nominated date in 2022 contingent on completion of phase 2 implementation.
This would be with the exception of the proposed Local Injuries Unit and the Medical Assesment Unit services which 'will be enabled prior to transition and will have a defined overlap with A&E.
The first step in the implementation plan was due to start in January 2017 with the approval of more than €100 million for its implementation. The DMHG also wanted to begin assessing the cost of expanding Tullamore hospital earlier this year.
The Minister for Health Simon Harris must give the go-ahead for implementation. He has not done so. It is not clear what preparatory work may have taken place without his sanction.
However, an appendix to the plan does set out detail structures for implementation.
The plan says implementation will be completed by working groups and be managed by a project manager accountable to a steering committee. The programme sponsor is the lead author of the plan, Dr Susan O'Reilly, Dublin Midlands Hospital Group Chief executive.
The plan says the sponsor's role is to 'ensure the programme meets the defined objectives and delivers expected benefits'. The sponsor will oversee a steering committee which will oversee a programme management office.
There will be five 'workstream sponsors' for five more working groups covering medicine, emergency medicine/ICU, surgery, women's and infants, mental health.
As the sponsor, Dr O'Reilly will have the authority to allocate and provide resources and funding to the programme as well as 'approving deliverables and resolve risks'.
Mr Trevor O'Callaghan, DMHG Chief Operating Officer, 'shall act as her delegate'. He will also chair the steering committee.